Treatments for Sleeping abnormalities. Single most important aspect of ME (Found in over 90% of ME patients)

 

Important Note
If tests show that you suffer from any of these abnormalities / dysfunctions, you can view the treatment options available and discuss them with your own medical doctor or consultant. These treatments can only be undertaken with the permission and supervision of your own medical doctor

Sleep abnormalities are the single most important aspect of ME and are present in over 90% of all ME patients. Unrefreshing sleep is mentioned as one of the diagnostic criteria for ME in the CDC definition of 1994 and is also mentioned in the Canadian Criteria. Dr. Jacob Teitelbaum successfully treated many ME patients and he has stated that a combination of mental and physical exhaustion and an inability to sleep, chronic insomnia, is one of the main factors in ME / CFS. Unrefreshing sleep over the course of a few weeks or months adversely affects immune system function, brain function, heart function, the endocrine system, the body's repair systems and capacity to recover, one's energy levels, etc.. It has multiple negative effects on the body. Most ME patients are not getting enough Deep Sleep or Stage 3 and 4 sleep. There is a severe loss of Deep Sleep over a long period of time in most ME patients and all Fibromaylgia patients. Resolving the Deep Sleep problem in ME / CFS patients will bring about dramatic improvement in health for all patients, though not full recovery. It is just one of several abnormalities and dysfunctions which need to be rectified in ME patients to move them towards full recovery.

  • After attending a sleep clinic and checking for Narcolepsy, obstructive sleep apnoea, central sleep apnoea, primary sleep disorder, night epilepsy, restless leg syndrome, night panic attacks, sleep walking, excessive NMDA activity in the brain at night - if you have any of these problems then seek immediate medical assistance and treatment.
  • Inflammatory cytokines can disrupt sleep and cause insomnia. Test for excessive inflammatory cytokine activity before sleep and while sleeping at night. If you have this problem then seek medical assistance to get medical treatment for it, and also consider taking supplements under the advice and supervision of your medical doctor.
    Reduce inflammatory cytokines
  • The first line of treatment should be to normalise melatonin levels, GABA levels and serotonin levels and reduce inflammation and inflammatory cytokines at night, and restore the normal circadian rhythm. The following can assist in this
    • Chinese Skullcap or Baicalin powder contains high levels of melatonin and stimulates GABA and improves serotonin levels. It also reduces inflammatory cytokines
    • Melatonin supplements
    • GABA supplements
    • 5HTP supplements or supplements to improve serotonin levels
  • Treatment recommended by Dr. Paul Cheney, CFS expert,  USA
    Klonopin for sleep. "No one should take drugs if they do not need them for medical reasons and Klonopin is no different but a low energy state with low cardiac output such as CFS will devastate sleep and loss of redox control kills brain cells and Klonopin is strongly indicated in this circumstance, in my opinion, with 30 years of observing Klonopin use in CFS patients. Klonopin along with high dose, injectable hydroxyB-12 (30-60 mg per day) and low dose injectable Magnesium (0.1 cc) with Taurine (0.1 cc) and perhaps Inosine in some patients with serum Uric Acids below 6.0 have been a staple for treating CFS for decades. There is a reason for this success and all these drugs or supplements powerfully affect the redox state whose instability and poor buffering is the core of CFS and a major threat to brain cells, especially from CNS hypo-perfusion due to low cardiac output which is itself due to mitochondrial deficiency as published for CFS by Hollingsworth et al, Shungu et al, Nicholson et al and McLaren-Howard et al." Dr. Paul Cheney, Cheney Clinic, USA.

    Dr. Paul Cheney says that there are two extreme states that the brain can be in: (i)  Seizure, associated with excess NMDA activity  or  (ii)  Coma , associated with GABA activity. CFS patients tend to be in the seizure state, with excess NMDA activity in the brain preventing a restful sleep. This  explains the disrupted sleep, the irritability,  the problems with lights being too bright, sounds being too loud etc.  This problem can be alleviated by pushing patients towards a coma state at night when they go to sleep. This will facilitate deep healing and recovery from illness. The following are recommended:Klonopin (Clonazepam)  0.5mg to 1 mg  -  take 1 to 2 hours before bedtime  and  Doxepin  - low dosage,  take 1 hour  before bedtime. Dr. Paul Cheney recommends 2 or more 0.5 mg tablets of Klonopin (Clonazepam) at night. 

    Also, very small doses (usually a quarter to a half a tablet) in the morning and mid-afternoon improve cognitive function and energy. Klonopin and Doxepin inhibit NMDA and increase GABA, giving one a deeper and more restful sleep. Also take Magnesium 500mg  before bedtime. The following also stimulate GABA activity in the brain  - Valerian, Taurine, GABA, Kava Kava, Magnesium, Skullcap, Hops and Passionflower. Consult a doctor before taking any of these medications or herbs.

    A.  Stimulate GABA in the brain:

    • Memantine, a medical drug has powerful anti-NMDA qualities

    • A medical doctor should closely supervise this sleep or neurotransmitter therapy. Your medical doctor should specify the combination of drugs, supplements and herbs below you should take for sleep purposes.
    - Klonopin (Day and Night) [Klonopin is a benzodiazepine (the same class of drugs as Valium) used to prevent seizures in children.]
    - Dr. Cheney uses Neurontin (gabapentin) in resistant cases to protect the brain, but thinks some doctors are using doses that are too high
    - Lorazepam
    - GABA (500 mg.-1500 mg./Night)
    - Valerian Root (Night) [an herb traditionally used to improve sleep]
    - Magnesium 500mg twice a day
    - Injectable Magnesium
    - Green tea or L Theanine
    - Kava Kava
    - Passionflower
    - Taurine
    - Dr. Cheney points out that selective serotonin reuptake inhibitors (SSRIs), the class of anti-depressants including Prozac, Zoloft, and Paxil, work by increasing the firing of neurons. He believes these drugs can have bad effects when taken for depression for periods of several years, and they would be even worse for CFIDS patients.


B. Stimulation of Serotonin in the brain and nervous system:
A medical doctor should closely supervise this sleep or neurotransmitter therapy.

Some medical drugs gently increase Serotonin levels in the brain. Molipaxin 75 -100mg  or  Doxepin Elixir (10mg/ml) or L-Tryptophan  1 hour before bed-time.
OR
5-HTP 200mg - 500mg, 2 hours before bedtime at night. Take on an empty stomach. and
Griffonia Simplicifolia and
L-Trytophan

Tryptophan rich Foods
Take tryptophan-rich snack(s) during the day and before bed-time.
turkey, milk, banana, avocado, wheatgerm, pumpkin seeds, chicken, tofu.
Tryptophan is converted into Serotonin in the brain.
and
Take vitamin B-Complex and Fish oils / Omega-3 oils. This helps convert Tryptophan into Serotonin in the brain.
and
Get 8-10 hours of direct sunlight every day. In Winter use a special light box. Include walking and stretching in the direct sunlight. Sunlight stimulates the production of Serotonin in the brain. Walking and Stretching improves nerve conduction.
- some ME clinics use this (1)

C.  Glycine. Reduces NMDA activity, Neuro Excitability and Relaxes the Nervous System.
Studies show that Glycine 3g or more before bed time, can improve sleep quality.
Research listings

D. Stimulate Melatonin in the brain:
A medical doctor should closely supervise this sleep or neurotransmitter therapy.

  • Melatonin tablets / powder 5 - 10mg, 1 hour before bed-time
  • Rozerem (ramelteon)

Research articles & Clinical Findings

-  van Heukelom RO , Prins JB , Smits MG , Bleijenberg G . Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Eur J Neurol. 2006 Jan;13(1):55-60. PMID: 16420393
- http://virtualhometown.com/dfwcfids/medical/cheney.html  (Dr. Paul Cheney's recommendations)
www.chronicfatiguesupport.com
www.keephope.net 
http://www.diagnose-me.com/ta-q.html
www.remedyfind.com
Chronic Fatigue, Fibromyalgia, and Lyme Disease (Alternative Medicine Guides) (2nd Edition) by Burton Goldberg and Larry Trivieri

  • Medical drugs for promoting Deep Sleep or Stage 3 and 4 Sleep and Sleep duration and Time needed to get to sleep
    • Dr. De Meirleir prescribes anti convulsant medication which increases GABA. He has found this very effective. Dr. Kenny De Meirleir recommends NexavirR and claims his patients often sleep normally after 3 days. If sleep cycle shift is present he treats with melatonin (6 mg)



    • Xyrem is the most effective medical drug for promoting Deep Sleep. It is very effective in ME/CFS and in Fibromyalgia.
      Sodium oxybate (Xyrem) has been used for narcolepsy, as it greatly enhances deep level sleep. Spitzer and Broadman report that 59% of ME/CFS and FM patients who tried this medication reported substantial relief of pain, and 75% had significant reduction of fatigue
      Research articles
      - A. R. Spitzer and M. Broadman, "Treatment of the Narcoleptiform Sleep Disorder in Chronic Fatigue Syndrome and Fibromyalgia with Sodium Oxybate," Pain Practice, Vol. 10, No. 1, 2010, pp. 54-59.
      - H. Moldofsky, N. H. Inhaber, D. R. Guinta and S. B. Alvarez-Horine, "Effects of Sodium Oxybate (Xyrem) on Sleep Physiology and Sleep/Wake-Related Symptoms in Patients with Fibromyalgia Syndrome: A Double-Blind, Randomized, Placebo-Controlled Study," Journal of Rheumatology, 2010
    • Suvorexant - can improve sleep duration and reduce the time needed to get to sleep.
    • Ambien, Amitriptyline, Trazadone, Clonazepam, THC (legalised form), GHB (legalised form) are all useful to varying degrees.
    • Baclofen increases GABA which is necessary for sleep
  • Aim to get 8 - 10 hours of deep sleep every night. This is stage 3 and 4 sleep, the most regenerative and healing form of sleep. This is important for all ME patients and vitally important for those people suffering from Fibromyalgia.
  • Go to bed 1 - 2 hours before midnight every night. This enables your body to adapt to it's natural rhythms, the circadian rhythms, which have existed among humans for 10,000 years.
  • Be in a darkened room for 2 hours before bed time. This will naturally increase your melatonin levels.
  • Get 6 - 7 hours of daylight or sunlight during the day, every day. In Winter, the use of light boxes will be necessary. This light is important for hormonal functions and will help normalise your hormones over time.
  • Caffeine is associated with sleep problems and neuro-excitability in ME patients. Eliminate caffeine from your diet. This will involve eliminating coffee, strong teas, and chocolate from your diet.
  • Amino acids are critical for brain function. Trytophan has been found to be low in ME patients. Test for amino acids. If levels are low, then use supplements to normalise levels. AND ensure there is adequate stomach acid and digestive enzymes in your stomach to absorb these amino acids.

Audio Visual and Meditation and Neurofeedback Systems

  • Treatment recommended by Dr. Charles Lapp, CFS expert,  USA
    Start with over-the-counter products like melatonin, valerian, Tylenol PM.  Pharmacologically, the best combination is Klonopin (Clonazepam) 0.5-1mg (to initiate sleep) and Trazodone 25-50mg (to maintain sleep); otherwise, Ambien and the benzodiazepines (Restoril, ProSom, Halcion) may be helpful but patients tend to develop tolerance over time.
  • Treat D-Ribose Deficiency
    • Teitelbaum, J. E., Johnson, C. & St Cyr, J. The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. Journal of alternative and complementary medicine (New York, N.Y.) 12, 857–62 (2006).
    • Teitelbaum, J., Jandrain, J. & McGrew, R. Treatment of Chronic Fatigue Syndrome and Fibromyalgia with D-Ribose– An Open-label, Multicenter Study. The open pain journal 32–37 (2012).
  • Homeopathy
    • The Homeopathic remedy SOMCUPIN spag. drops is very effective.

  • Some doctors recommend Phenergan (Promethazine) which is an anti-histamine and a strong sedative
  • Some doctors recommend sleeping tablets an sedatives such as Ambien, Xyrem, Zalelpon, Zopiclone or low dose anti-depressants with sedative effects such as low doses of Amitryptilene or Doxepin or Trazadone at night.
  • A hot bath before bedtime and high carbohydrate meal a few hours before bed. Also 30 minutes to 1 hour of meditation at night can help improve overall sleep.
  • Bood sugar levels can disrupt sleep. If this is a factor, go on a diet to balance blood sugar at night / prior to going to sleep.
  • Lifestyle Changes and Relaxation
    • Meditation is recommended
    • Listen to Meditative music in the evening and at night
    • Use relaxation and sleep CD or mp3 music in bed
    • When lying in bed, relax the body and the mind. Relax your breathing and breathe deeply. Don't give a damn about anything that comes to mind when trying to sleep. Let the thoughts enter and pass by your mind, do not become involved in them or think about them
    • Feel your body and your mind becoming heavier and heavier with sleep. Drift deeper and deeper into sleep.
  • Re-designating old medical drugs for CFS Treatment
    CFIDS Association of America has got Biovista ( http://biovista.com ) in the USA to engage in research and data mining of thousands of medical drugs (including some which are currently out of use) and find matches between them and the symptoms, abnormalities and dysfunctions found in ME. They are compiling a list of these medical drugs. Safety guidelines, side effects, clinical reports and general efficacy and other factors will also be taken into account for each medical drug
  • Stress Reduction
    In addition to getting medical treatment for immune system, krebs cycle and methylation cycle dysfunctions, infections and other biological abnormalities and dysfunctions one should also get Stress Reduction treatment as all physical illnesses including Cancer, AIDS, ME, Multiple Sclerosis, Fibromyalgia, autoimmune illness, Cardiac related illnesses, advanced Diabetes, etc. causes great stress for patients. Click here for Stress Reduction treatment


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